Paraneoplastic Musculoskeletal Syndromes

Khan, Fahad; Kleppel, Hilary

doi:10.1016/j.rdc.2020.04.002

Cited by 9 publications

(5 citation statements)

References 28 publications

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“…Paraneoplastic phenomena may be the first sign of undiagnosed cancer, as in this case. Although the clinical manifestations of tumors and paraneoplastic syndromes are different, clinicians should realize that paraneoplastic phenomena are not caused by tumor mass effects or metastasis[ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…The most commonly reported paraneoplastic syndromes were hematological followed by rheumatological, dermatological, endocrine and neurological syndromes[ 1 ]. Therefore, diseases that feature an advanced age at onset, significant constitutional upset, and otherwise atypical characteristics should increase the index of suspicion for a paraneoplastic syndrome[ 2 ]. Like other solid tumors, lymphoproliferative diseases, and hematological cancers, hepatocellular carcinoma (HCC) has a few reports about paraneoplastic phenomena, including hypoglycemia[ 3 ], hypertension[ 4 ], hypercalcemia[ 5 ], Raynaud’s phenomenon (RP)[ 6 ], and dermatomyositis[ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Severe digital ischemia coexists with thrombocytopenia in malignancy-associated antiphospholipid syndrome: A case report and review of literature

Chen¹,

Yu²,

Luo³

et al. 2021

WJCC

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BACKGROUND Paraneoplastic syndromes are characterized by atypical clinical manifestations. Several reports of hepatocellular carcinoma (HCC) paraneoplastic phenomena have been reported. They usually manifest as one type in an individual, but it is not common for the two clinical manifestations to occur simultaneously. CASE SUMMARY A 52-year-old female patient was admitted to hospital with pale skin and numbness of the second to fifth fingers in the left hand, which rapidly developed into severe digital ischemia. Computed tomography angiography revealed uneven thickness of the left ulnar artery with severe local luminal stenosis. Blood analysis during hospitalization showed persistent mild to medium thrombocytopenia and insensitive to hormonal therapy. Antiphospholipid antibody testing showed high titer of IgG anticardiolipin antibodies (aCLs), IgA aCLs, IgG anti-β2-glycoprotein-I (anti-β2 GPI), and IgA anti-β2 GPI. The exact diagnosis was HCC when the high a-fetoprotein levels, computed tomography findings, and the history of chronic hepatitis B came together. This was a rare case of coexisting manifestations as presenting symptoms of malignancy-associated antiphospholipid syndrome. The patient underwent several operations, antithrombotic treatments and hormonal therapy. However, the patient refused chemotherapy and died 8 wk after diagnosis. CONCLUSION This report highlights the importance of atypical clinical changes that could alert the physicians to vigilance for a concomitant underlying malignancy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Severe digital ischemia coexists with thrombocytopenia in malignancy-associated antiphospholipid syndrome: A case report and review of literature

Chen¹,

Yu²,

Luo³

et al. 2021

WJCC

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“…Within 2 years of onset, 3% to 15% of patients with dermatomyositis will be found to have an underlying malignancy (eg, GI, ovarian, nasopharynx, breast), and the risk may be higher in patients with amyopathic disease, dysphagia, rapid progression, recurrence of symptoms on steroid taper, and high creatine kinase levels, and in male patients and those between 15 and 50 years old. 69 "Honeycomb" edema on MRI of the quadriceps muscles has also been associated with an 85% increased risk of malignancy. 70 A variety of antibodies have been described in dermatomyositis, and antinuclear matrix protein 2, anti-melanoma differentiation-associated protein 5, and anti-transcription intermediary factor-γ antibodies have been associated with an increased risk of underlying malignancy.…”

Section: Muscle Syndromesmentioning

confidence: 99%

“…One-half of patients with dermatomyositis have typical skin changes preceding myopathic symptoms including heliotrope rash (upper eyelid and “shawl” distribution) and Gottron’s erythematous papules in a linear pattern on the extremities, especially the dorsal and lateral aspects of the hands and fingers but also overlying joints. Within 2 years of onset, 3% to 15% of patients with dermatomyositis will be found to have an underlying malignancy (eg, GI, ovarian, nasopharynx, breast), and the risk may be higher in patients with amyopathic disease, dysphagia, rapid progression, recurrence of symptoms on steroid taper, and high creatine kinase levels, and in male patients and those between 15 and 50 years old 69 . “Honeycomb” edema on MRI of the quadriceps muscles has also been associated with an 85% increased risk of malignancy 70 .…”

Section: Muscle Syndromesmentioning

confidence: 99%

Paraneoplastic Neurologic Syndromes

Graber

2023

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE Progress is ongoing in understanding paraneoplastic neurologic disorders, with new syndromes and antibodies being described and more detailed evidence available to guide workup for diagnosis and treatment to improve outcomes. Many excellent reviews have summarized the molecular features of different antibodies, but this article emphasizes the clinical features of each syndrome that may help guide initial diagnosis and treatment, which often should occur before an antibody or cancer is found to confirm the diagnosis. LATEST DEVELOPMENTS Recent findings include updated diagnostic criteria with validated sensitivity and specificity, discovery of novel antibodies, and clinical findings that increase the likelihood of an underlying paraneoplastic disorder. Suggestive syndromes that have been recently identified include faciobrachial dystonic seizures and pilomotor auras in anti–leucine-rich glioma inactivated protein 1 encephalitis, extreme delta brush on EEG in N-methyl-d-aspartate (NMDA)-receptor encephalitis, déjà vu aura in anti–glutamic acid decarboxylase 65 (GAD65) encephalitis, and sleep disturbances in several disorders. In addition, there is confirmed utility of brain positron emission tomography (PET) and CSF markers, including carcinoembryonic antigen and oligoclonal bands, as well as improved tests for the presence of leptomeningeal cancer cells in CSF. Associations of cancer immunotherapies with paraneoplastic syndromes and herpes simplex virus encephalitis (and COVID-19) with NMDA-receptor encephalitis have been described. ESSENTIAL POINTS All neurologists should be aware of advances regarding paraneoplastic neurologic syndromes, as patients can present with a wide variety of neurologic symptoms and earlier diagnosis and treatment can improve outcomes.

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“…During the first 3 years to 5 years after the onset of DM, the risk of cancer is increased, rarely hepatocellular carcinoma. Since DM can be associated with malignancy as a paraneoplastic syndrome[ 144 ], sporadic cases had HBV-associated hepatocellular carcinoma with a concurrent or later diagnosis of DM[ 145 , 146 ].…”

Section: Iimmentioning

confidence: 99%

Autoimmune liver diseases in systemic rheumatic diseases

Wang¹,

Tsai²

2022

WJG

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Systemic rheumatic diseases (SRDs) are chronic, inflammatory, autoimmune disorders with the presence of autoantibodies that may affect any organ or system. Liver dysfunction in SRDs can be associated with prescribed drugs, viral hepatitis, alternative hepatic comorbidities and coexisting autoimmune liver diseases (AILDs), requiring an exclusion of secondary conditions before considering liver involvement. The patterns of overlap diseases depend predominantly on genetic determinants with common susceptible loci widely distributing in both disorders. In AILDs, it is important to identify the overlapping SRDs at an early stage since such a coexistence may influence the disease course and prognosis. Commonly co-occurring SRDs in AILDs are Sjögren syndrome (SS), rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) in autoimmune hepatitis (AIH), and SS, RA or systemic sclerosis in primary biliary cholangitis. Owing to different disease complications and therapies, it is imperative to differentiate between SLE liver involvement and SLE-AIH overlap disease. Therapeutic options can be personalized to control coexisting conditions of liver autoimmunity and rheumatic manifestations in AILD-SRD overlap diseases. The collaboration between hepatologists and rheumatologists can lead to significant advances in managing such a complex scenario. In this review, we provide a comprehensive overview on coexisting AILDs in different SRDs and the therapeutic approach in managing these overlap diseases.

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Paraneoplastic Musculoskeletal Syndromes

Cited by 9 publications

References 28 publications

Severe digital ischemia coexists with thrombocytopenia in malignancy-associated antiphospholipid syndrome: A case report and review of literature

Severe digital ischemia coexists with thrombocytopenia in malignancy-associated antiphospholipid syndrome: A case report and review of literature

Paraneoplastic Neurologic Syndromes

Autoimmune liver diseases in systemic rheumatic diseases

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